The Big Question: Why has rugby union become so dangerous, and what should be done?

Why are we asking this now?

Rugby union is a rough, tough sport – but lately it has become a whole lot more so, and the cost in terms of injured players is so great that clubs and officials are debating whether action needs to be taken to stem the tide. Rule changes are being spoken of as the new breed of colossal player – far bigger, stronger and faster than those of previous generations – inflict serious damage on each other.

How serious is the problem?

The England team that kick off their autumn programme against Australia at Twickenham on Saturday have been so devastated by injury that it will be an almost unrecognisable XV that pull on the red rose jersey. Martin Johnson, England's former World Cup winning captain turned manager, has lost 12 of his original 32-man elite squad to a bewildering array of scrapes, strains, breaks and bumps. Of the 64 players chosen by Johnson in his elite and second-string squad, a complete match-day line-up of 22 players will be nursing their wounds this weekend. "We are having a bad a run as there has been," Johnson said.

Is it an English disease, or are other countries suffering as well?

It is by no means confined to English rugby. Medical bulletins seem to occupy the lion's share of any team announcement these days. Wales, who play New Zealand on Saturday, are missing a fistful of players, notably a couple of their British Lions, Lee Byrne and Adam Jones, and yesterday they lost Mark Jones after he was injured in training. South Africa also suffered yesterday when their star No 8 Pierre Spies pulled out of the tour to the UK. Over the summer's tour to South Africa, the Lions were forced to repatriate 10 players.

Is it just about players' size and strength?

According to James Robson, a Scot who has been the Lions doctor since 1993, the problem has arisen because players are becoming too big. According to others, however, the problem is the amount of rugby being played and the intensity demanded in the professional era. There's also the matter of a change of emphasis in the tackle. Now players are encouraged to go higher to take man and ball instead of the old style of snatching your man round the legs, and that is more physically dangerous.

Could it just be a case of bad luck?

England have never suffered such a run of injuries, but yes there is an element of luck about it. Johnson has lost three props, a position that suffers strain like no other. But one of them, Julian White, strained a hamstring, which is almost unheard of among the weightier brethren of the front row. Andrew Sheridan dislocated his shoulder; an injury that has been commonplace since William Webb Ellis put in his first tackle, and Phil Vickery can rival Jonny Wilkinson for time spent on the treatment table. "Just another blow on the head for Phil," is how one seasoned rugby watcher puts it. Perhaps most surprisingly of all given his long history of injuries, Wilkinson is actually fit – although the game is still three days away. England's list includes three hamstrings, three shoulders, a couple of knees, a foot and a toe, so there is no obvious problem area.

How much bigger than his predecessors is the modern-day player?

A lot. The difference between Clive Woodward, an England threequarter in the 1980s, and Matt Banahan, who made his debut as an England winger this year, is huge. Mathew Tait, a threequarter who is considered on the small side these days, is 14st 4lb, but that makes him heavier than all but one of the England side that played Wales in 1923. Players on average have become nearly three stone heavier and four inches taller over the last half century. Thirty years ago Paul Dodge, who also played in the centre, at 6ft 1in was nicknamed the Colossus yet he weighed less than 13st, which makes him the size of many schoolboy players these days. And over the past decade the increase has accelerated, with forwards on average a stone and a half a man heavier. It is the combination of taller, heavier and, in particular, more muscular players that has unquestionably led to heftier hits. The bigger they are the harder they are definitely falling. "Players are too muscle bound and bulky," says Dr Robson.

But aren't injuries inevitable?

It's true that the man with the bucket and sponge has always had his part to play. But there is extensive evidence that since the game went professional in the mid-1990s, injury has become increasingly commonplace. The RFU are currently working on a detailed injury audit, but an extensive study was done on the Guinness Premiership, England's domestic competition, between 2002 and 2004 and revealed that one in four players was out of action at any one time and each player spent on average 19 per cent of his time injured.

So is professionalism to blame?

The game has undoubtedly intensified since players went full-time, becoming almost a victim of its own progress. Club rugby is notably more demanding. The ferocity of the Premiership can be held to account for England's particularly high casualty rate. It has been described by Dr Mick Molloy, chief medical officer of the International Rugby Board, as the "toughest competition in the world, week in and week out".

The introduction of the Heineken Cup, involving clubs from the home nations and Continental clubs, brought a new level of competition to the game. The season has been lengthened, and as a result there is less time off for the top players. Players simply cannot put up with the strain. It is not only the matches that are more intense. Training too is a level higher and there has been a rise in the number of players picking up injuries inbetween games. Lawrence Dallaglio, the former England captain who retired in 2008, underwent nine operations during his career, but points out that the recovery period is now much shorter and the general medical care better than ever. For all the bad publicity in the summer over eye-gouging, professionalism has seen the sport become much less violent. Being on the end of a "shoeing" at the bottom of a ruck used to be a rite of passage, but with the proliferation of cameras at most games those days that has been consigned to rugby folklore.

Why don't rugby players wear more protection?

For a time after the game turned professional, players did pad up. Body armour and head protection – basically scrum caps with extra stuffing – became fashionable, but their use has tailed off as it made little difference to injury. If anything it encouraged players to be more reckless, buoyed by a false sense of security. Adding any significant padding would also fundamentally change the nature of the sport. American Football has shown that squeezing every last body part into protective clothing does little to reduce injury.

What are the authorities going to do about it?

The IRB are holding an inaugural medical conference in London next month. Rule changes such as a ban on "gang-tackling" have been mooted, but there is a general reluctance within the game to tinker too much. It is a full contact sport and there is no appetite to change that, be it among players or officials.

Does rugby union now have a serious problem?

Yes...

* Any sport that is regularly stripped of its best players will become less attractive to viewers and sponsors

* Why would you encourage your child to take up a sport that could see them seriously hurt?

* Players have become both bigger and quicker and the game is suffering the inevitable consequences

No...

* The game might be tougher but it is also faster and more exciting as a result of players' improved condition

* Injury has always been part and parcel of a game that has contact at the core of its existence

* Recovery time is much shorter than it has ever been because medical care is so much better

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